GILBERT: Healthy Medicaid program important for everyone

But nearly 20 percent of Michigan's population depends on the program, according to the Citizens Research Council of Michigan, which has offices in Lansing and Livonia.

Medicaid -- the nation's insurance program for those who can't afford it -- covers more than 58 million low-income Americans, including families, people with disabilities and the elderly. Administered and in part paid for by the states, it provides coverage for almost 29 million children and pays for approximately half of the nation's long-term care costs, according to the Washington, D.C.,-based Families USA, a health-care advocacy group.

No one can blame skeptics of the federal government's pledge to pay all the costs for an expansion of Medicaid for three years before beginning to assign some of the expense to the states.

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The feds say they plan to pay 90 percent of the cost in perpetuity, but we all know that when it comes to government, promises mean very little.

As the non-partisan CRC pointed out in a study last year, Medicaid spending in Michigan continues to grow at a rate faster than the economy and there are few funding sources that can keep up.

And this is for the program as it is, not how it would be if expanded.

"While Medicaid spending contributes to state economic activity, it continues to stress state resources," the study concluded. "Even with recent revenue changes, the majority of Medicaid financing is growing at a rate slower than the costs of Medicaid, and state policymakers will grapple with revenue-raising options in order to maintain Medicaid services. The challenge for state policymakers is to agree on a funding method for Medicaid that ensures the integrity of the program now and in the future, without compromising other state spending priorities.

"A main function of the state budget is to prioritize services; as such, Medicaid has been dominating the budget as the number of patients served and benefits provided have increased. Michigan policymakers need to decide whether to allow Medicaid to continue to crowd out other important programs. This has been, and will continue to be, the fiscal dilemma facing policymakers."

However, CRC researcher Nicole Bradshaw also pointed out that the program "helps reduce costs in the long run."

The relevance is the decision Michigan lawmakers face as they decide whether to expand the program as part of Obamacare, making hundreds of thousands more people eligible.

While costly, it should never be forgotten that Medicaid pays health-care costs for the indigent that otherwise would be indirectly shifted to people who have health insurance in the form of higher premiums.

For this reason, it must be pure spite that is preventing Republican lawmakers from approving the expansion. Having failed to achieve the death of Obamacare in Congress, courts and the ballot box, they now want it to fail. There is no other logical explanation.

In fairness, CRC pointed out that last fiscal year, over 15 percent of Michigan's spending from state sources was appropriated to Medicaid, up from less than 10 percent a decade ago and despite a nearly 16 percent decline in real total state spending from state sources. As a result, while Medicaid's budget increased 30 percent in inflation adjusted terms, most other state budget areas declined in the same period: revenue sharing for local governments (-47.0 percent); higher education (-45.4 percent); community colleges (-25.7 percent); human services (-21.3 percent); K-12 school aid (-21.2 percent); and corrections (-2.3 percent).

But what are we supposed to do about people who, through no fault of their own in many cases, simply cannot afford health insurance? One way or another -- whether in emergency rooms or less expensive clinics and doctors' offices -- we will pay for their health care.

In fact, a minority of Republican lawmakers agree with Republican Gov. Rick Snyder, who 10 days ago excoriated the Senate for failing to approve the expansion.

"We're basically subsidizing the rest of the United States," Snyder said. "Isn't it better to say we're going to try a solution instead of simply saying no? ... Isn't it better to try a solution knowing it may have risks, that it's not perfect, that it has challenges, that we're going to be held accountable for delivering measurable, tangible results? I accept that challenge. I believe the Michigan of the future requires us to accept that challenge and get this job done."

The CRC outlined several possible solutions to the long-term financing problem, all on the unpopular tax side, however.

We could beat up on smokers again by raising the tobacco tax.

"Tobacco use increases medical costs and one study using 2004 data estimated Michigan's annual Medicaid smoking related costs to be 13 percent of total Medicaid spending or $727 million," the CRC study said.

The governor's office has estimated these costs to be $1.1 billion for the state.

Other states have attempted to levy excise taxes on soft drinks, vending machines and other unhealthy food and beverage choices in order to raise revenues while encouraging healthier food choices, the CRC notes. Approximately half of the states levy a tax on soft drinks. That would require a constitutional amendment, however, since Michigan's constitution forbids taxation of food and beverages. (Only prepared foods are taxed.)

"Any budget solution should also acknowledge the need that low-income Michigan residents have for quality health care," the CRC study said. "Many of the budget challenges come from rapidly rising healthcare costs, and those who benefit most from these services, such as pregnant woman, children and the disabled, are often casualties in this debate. The tradeoff between budget priorities and Medicaid recipients should be prominent in this discussion."

Everyone has a stake -- financially and morally -- in the outcome of the Medicaid debate.